[Developments in the surgical treatment of rectal cancer in view of the quality of life]

Abstract

The quality of life of patients who had undergone a primary radical resection of the rectum for cancer was restricted by colostomy, urinary incontinence or sexual disturbance. This paper describes the developments and surgical results of sphincter saving operation and nerve preserving operation for rectal cancer. 1) Sphincter saving operation: With the advent of modern sphincter saving techniques such as low anterior resection and stapling technique, abdomino-perineal resection of the rectum are no longer necessary for the treatment of nearly all tumors of rectosigmoid, three of four tumors of the upper rectum and one of five tumors of the lower rectum. At low anterior resection of the rectum, in general principle, the affected parts of the diseased rectum were resected with a macroscopically free margin of at least 3 cm on anal side of the cancer. Recurrence rates of anterior resection were fewer than those of abdomino-perineal resection, and five year survival rates after AR were better than those of after APR. 2) Autonomic nerve preserving operation: As it is impossible to remove the internal iliac lymph-nodes completely without disturbing the underlying pelvic plexus, an autonomic nerve preserving operation was done unless there was microscopic lymphatic gland involvement by frozen section. Urinary bladder function was impaired in 80% of patients after extended lateral dissection without nerve preservation whereas it was unaffected in 14 of 16 patients after nerve preserving operation. Six of seven male patients with nerve preserving operation retained potency, but only one was capable of ejaculation.